摘要
目的 调查研究广西北部地区某大型三级甲等医院耐碳青霉烯肠杆菌(CRE)分布特征及耐药特点,为临床医师抗感染治疗提供实验依据.方法 回顾性调查分析2019-2023年桂林地区某大型三甲医院所有送检标本分离出CRE的病原菌资料,其中血培养用法国梅里埃血培养仪(BACT/ALERT 3D),鉴定系统采用梅里埃质谱仪(VITEK MS)鉴定,药物敏感试验采用VITEK2 COMPACT全自动微生物药敏分析仪、联合纸片扩散法(KB法)、改良Hodge试验及乙二胺四乙酸(EDTA)协同试验,通过WHONET5.6软件对所有病原菌资料进行统计分析汇总.结果 该院5年共检出肠杆菌12 449株,其中CRE806株占6.47％,2019-2023 年 CRE 检出率依次为 4.62％(45/975)、5.77％(39/676)、5.10％(121/2 375)、6.97％(256/3 672)、7.26％(345/4 751).CRE菌药敏试验显示:本地区的CRE阿米卡星耐药率45.20％、替加环素耐药率为48.50％、复方新诺明26.26％.2023年有对上述抗菌药物全耐的菌株87株.通过体外协同药敏试验:美罗培南联合磷霉素阳性率为55.17％、美罗培南联合替加环素阳性率为43.68％、美罗培南联合多黏菌素阳性率为46.00％;替加环素联合多黏菌素的阳性率为81.61％、单用头孢他啶阿维巴坦的阳性率为79.31％.结论 该地区检测出CRE以肺炎克雷伯菌为主,2019-2013年分离率总体趋势逐年升高;分布的科室以重症监护室、呼吸重症科为主;标本来源为痰液、肺泡灌洗液为主;联合药敏显示碳青霉烯类抗菌药物联合磷霉素,或者替加环素、多黏菌素或者单用头孢他啶阿维巴坦有较好的敏感性,对临床治疗CRE具有较高的指导价值.
Abstract
Objective To investigate the distribution and drug resistance characteristics of carbapenem resistant Enterobacterales(CRE)in a large tertiary hospital in the Northern Region of Guangxi,and provide experimental basis for clinical physicians to treat infections.Methods A retrospective survey was conducted to analyze the pathogen data of CRE isolated from all specimens submitted to a large tertiary hospital in Guilin from 2019 to 2023.The blood culture was performed using the French Merit blood culture instrument(BACT/ALERT 3D),the identification system was identified using the Merit mass spectrometer(VITEK MS),and the drug sensitivity test was performed using the VITEK2 COMPACT automatic microbial susceptibility analyzer,combined paper diffusion method(KB method),improved Hodge test,and EDTA collaborative test.All pathogen data were statistically analyzed and summarized using the WHONET5.6 software.Results A total of 12 449 strains of Enterobacteriaceae were detected in the hospital over the past 5 years,with CRE 806 strains accounting for 6.47％.The CRE detection rates from 2019 to 2023 were 4.62％(45/975),5.77％(39/676),5.10％(12/2 375),6.97％(256/3 672),and 7.26％(345/4 751),respectively.CRE bacterial susceptibility showed that the local CRE resistance rate to amikacin was 45.20％,the resistance rate to tigecycline was 48.50％,and the resistance rate to compound sulfamethoxazole was 26.26％.In 2023,there were 87 strains of bacteria that were fully resistant to the aforementioned antibiotics.Through in vitro synergistic drug sensitivity testing,the positive rate of meropenem combined with phosphomycin was 55.17％,meropenem combined with tigecycline was 43.68％,and meropenem combined with polymyxin was 46.00％.The positive rate of tigecycline combined with polymyxin was 81.61％,and the positive rate of ceftazidime avibactam alone was 79.31％.Conclusion Klebsiella pneumoniae has been detected as the main cause of CRE in the region,and the overall trend of isolation rate has been increasing year by year in 2019-2013.The distribution of departments is mainly ICU and respiratory intensive care unit,and the sample sources are mainly sputum and bronchoalveolar lavage fluid.Combined drug sensitivity shows that carbapenem antibiotics combined with phosphomycin,tigecycline,polymyxin,or ceftazidime avibactam alone have good sensitivity,which has high guiding value for clinical treatment of CRE and is worthy of clinical promotion and application.
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